Kawashiro Keita, Hotta Kiyohiko, Suzuki Rigel, Iwahara Naoya, Hirose Takayuki, Tsujino Shuhei, Fukuhara Takasuke, Shinohara Nobuo
Department of Urology, Hokkaido University Hospital, Sapporo, Japan.
Department of Urology, Hokkaido University Hospital, Sapporo, Japan.
Transplant Proc. 2025 Jul-Aug;57(6):1013-1017. doi: 10.1016/j.transproceed.2025.05.021. Epub 2025 Jun 28.
Vaccination with mRNA vaccines has significantly reduced the SARS-CoV-2 mortality rate in the general population. However, the effectiveness of mRNA vaccines in kidney transplant (KTx) recipients is unclear.
In this cohort, we compared the disease severity and seroconversion rate after SARS-CoV-2 infection in 30 vaccinated and 8 unvaccinated KTx recipients. KTx recipients have infected between February 2022 and September 2023 during the Omicron variant phases. We measured anti-SARS-CoV-2 spike protein IgG antibodies (cutoff value was 1.0 AU/mL). Furthermore, we investigated anti-SARS-CoV-2 spike protein IgG antibodies and the neutralizing antibody titer against BA.5 and BA.2.86 in 10 vaccinated KTx recipients before and after BA.5 infection.
The incidence of moderate disease was significantly higher in the unvaccinated group (P = .004). The median antibody titers after SARS-CoV-2 infection in vaccinated and unvaccinated KTx recipients were 244.5 (IQR: 43.5-757.8) and <1 (IQR: <1-<1) AU/mL, respectively (P < .0001). Surprisingly, none of the 5 patients with moderate disease developed detectable antibodies after infection. The antibody titers and neutralizing antibody titer against BA.5 and BA.2.86 variants in vaccinated KTx recipients increased significantly after BA.5 infection (S-IgG: P = .004, BA.5: P = .002, BA.2.86: P = .016).
Although vaccinated KTx recipients achieved IgG antibody and neutralizing antibody boost after SARS-CoV-2 infection, unvaccinated KTx recipients did not experience an increase in antibody titers and experienced more severe infections. Furthermore, KTx recipients acquired the neutralizing activity against Omicron BA.2.86 after Omicron BA.5 infection. Thus, vaccination should be recommended for KTx recipients.
接种mRNA疫苗显著降低了普通人群中SARS-CoV-2的死亡率。然而，mRNA疫苗在肾移植（KTx）受者中的有效性尚不清楚。
在该队列中，我们比较了30名接种疫苗和8名未接种疫苗的KTx受者感染SARS-CoV-2后的疾病严重程度和血清转化率。KTx受者在2022年2月至2023年9月的奥密克戎变异株流行阶段被感染。我们检测了抗SARS-CoV-2刺突蛋白IgG抗体（临界值为1.0 AU/mL）。此外，我们调查了10名接种疫苗的KTx受者在感染BA.5之前和之后针对BA.5和BA.2.86的抗SARS-CoV-2刺突蛋白IgG抗体和中和抗体滴度。
未接种疫苗组中度疾病的发生率显著更高（P = 0.004）。接种疫苗和未接种疫苗的KTx受者在感染SARS-CoV-2后的抗体滴度中位数分别为244.5（IQR：43.5 - 757.8）和<1（IQR：<1 - <1）AU/mL（P < 0.0001）。令人惊讶地是，5名中度疾病患者在感染后均未产生可检测到的抗体。接种疫苗的KTx受者在感染BA.5后，针对BA.5和BA.2.86变异株的抗体滴度和中和抗体滴度显著增加（S-IgG：P = 0.004，BA.5：P = 0.002，BA.2.86：P = 0.016）。
尽管接种疫苗的KTx受者在感染SARS-CoV-2后实现了IgG抗体和中和抗体的增强，但未接种疫苗的KTx受者的抗体滴度没有增加，且经历了更严重的感染。此外，KTx受者在感染奥密克戎BA.5后获得了针对奥密克戎BA.2.86的中和活性。因此，建议KTx受者接种疫苗。
